NEWBORN HEARING SCREENING: CHARACTERIZATION
OF DEMAND/TERRITORY AND HEARING TESTS
Triagem auditiva neonatal: caracterização
da demanda/território e exames auditivos
Amanda Ferreira Hernandez Rogério(1), Elizabeth Oliveira Crepaldi de Almeida(2), MarieneTerumi Umeoka Hidaka(3), Bárbara Carolina Teixeira Amado(4)
(1) Hospital e Maternidade Celso Pierro da PUC-Campinas, SP, Brazil.
(2) Speech Therapy Course at PUC-Campinas, SP, Brazil. (3) Speech Therapy Course at PUC-Campinas, SP, Brazil. (4) Hospital e Maternidade Celso Pierro da PUC-Campinas,
SP, Brazil.
Conlict of interest: non-existent
being dismissed from hospital as an ideal goal, allowing the infants who fail the tests to receive
adequate medical and audiologic evaluation to
conirm hearing alterations before they are three
months old 2-4.
In a conference carried out in 1993, the National Institute of Health recommended screening through Evoked Otoacoustic Emissions (EOAE), in all
newborns due to being a very eficient, objective,
non-invasive and low cost method, which makes the
evaluation of a large number of children viable 5,6.
In 2007, the JCIH3 made a new recommendation,
and suggested that quality indicators be used to
evaluate UNHS programs. Suggesting that the fail rate of UNHS before being dismissed from hospital
should not surpass 4%; where as when it comes to
the diagnosis, suggesting that 90% of the newborns sent for diagnosis be evaluated prior to completing three months and the identiication of hearing loss of 35dB minimum in the best ear; after diagnosis, it was recommended that 95% of the children with
INTRODUCTION
A program for detection of early deafness should
begin with NHS (Neonatal Hearing Screening),
followed necessarily by diagnosis and rehabilitation, contemplating the four necessary stages for the program to be effective: hearing tracking and/or
screening; audiologic diagnosis; indication, selection
and adaptation of hearing aids and hearing re(ha)
bilitation1.
The Universal NHS (UNHS) is the hearing tracking whereby all newborn babies should have
access to hearing screening, preferably before
ABSTRACT
Purpose: to characterize the demand, territory and hearing tests performed on a Newborn Hearing
Screening Program. Methods: retrospective study of a sample of 2334 records of newborns
screened, involving the analysis of data on Newborn Hearing Screening, Newborns of information and
demographic variables. Results: 88% were screened newborns, and of these 16% had Risk Indicator
for Hearing Impairment and 84% did not. It was observed that the indicator was the most prevalent family history, and that the chances of passing the test are lower in the presence of indicator and when the newborn’s weight less than 1,500 g. The index-pass test failure was 78% and 22% passes failure. On the test result, the greater number of failures unilateral and retest failure 4% being a membership of more than 70%. Conclusion: study like this allows the active pursuit of newborn risk group for
hearing impairment in their respective territories, with greater possibility of tracking and thus reach the primary goal of hearing screening is that the diagnosis of deafness until the third month life, in addition to designing a Neonatal hearing Screening Program effective in their steps: screening, diagnostic audiology, indication, selection and itting of hearing aids and re (ha) bilitation hearing.
the gender between female and male. The weight according to the deinition of Newborn with low
weight and Newborn with Very Low Weight8;
and lastly the gestational age according to the
International Illnesses classiication9.
The second stage was to analyze the data
obtained comparing the rates of screening carried out with the number of live births of the Sistema Único de Saúde, the percentage of Newborns
screened with or without RIHI, as well as the results
of the tests, the rate of attendance for retesting and the rate of newborns referred for diagnosis.
The study’s third stage was to analyze the quality
indicators of the NHS Program services, beginning with the number of test carried out.
The test carried out for NHS was the Transient
Evoked Otoacoustic Emissions (TEOAE) carried out using OTOPORT equipment - Otodynamics, with
frequencies from 1000 to 4000 Hz, with intensity of 70 dB. The result was registered considering the responses of the TEOAE in relation to signal/
noise, having as a criteria: Present – responses in
three consecutive frequencies or more; and Absent – responses in zero, one or two frequencies.
The screening was carried out close to hospital
discharge, both for the Newborns in Hospital Wards,
as well as those in Neonatal ICU.
All orientation to parents with regards to return
visits and the test results were annexed to the
newborn’s vaccination card and on the patient’s medical record. With retesting carried out as an outpatient at the PUC – Campinas Speech Therapy Clinic.
For cases where the newborn passed without RIHI, the newborn’s mother was orientated with
regards to the development of the child’s hearing
and language and consequentially the speech therapy approval.
For cases where the newborn Passed or Failed
with RIHI, apart from orientation about the devel
-opment and the need for a re-test in cases of failure, the mothers of the Newborn were orientated about the bi-annual return for hearing monitoring up until the age of three. And for the cases where there was
a Fail without RIHI they were booked to come back
for retesting within 30 days.
For cases of fail in retesting, the Newborn coming from Hospital Wards were evaluated by the ENT specialists within one week and after intervention and discharge were booked for a second retesting.
With regards to the Risk Indicators for Hearing Impairment used as a reference for the service, they
were those described in current literature 3,4,10,11. This protocol of speech therapy and ENT appointments, which includes a second retest after the evaluation of the ENT Specialist, had as its aim conirmed hearing loss begin using sound amplii
-cation, within one month.
In Brazil, in 2010 the Comitê Multiproissional em
Saúde Auditiva (COMUSA)4, after analyzing the liter -ature referring to identiication, diagnosis and early intervention in newborn and infants with hearing
impairment, also recommends steps towards a
program of neonatal hearing health3. In this same year, in Brazil, Federal Law Nº 12.303/2010 of the
2nd August 2010, was sanctioned by the President of the Republic Luiz Inácio Lula da Silva making
Evoked Otoacoustic Emissions tests obligatory and
free in Neonatal Hearing Screening for all babies
born in hospitals and maternities 7.
Within this context the following study has as its objective to characterize the demand, territory and hearing tests carried out in a Program for Neonatal
Hearing Screening.
METHODS
The data began to be collected after it was approved by the Research Ethics Committee of
the Pontifícia Universidade Católica de Campinas,
under protocol number 0400/1.
The study was carried out by the Residents in
Speech Therapy of the Hospital e Maternidade Celso Pierro (HMCP), responsible for carrying out
the screening through Transient Evoked Otoacoustic
Emissions (TEOAE) of the Sistema Único de Saúde
(SUS – Public Health Care System) patients.
The sample consisted of 2334 medical records of newborns screened by the NHS Program of
the HMCP, attended between February 2010 and
February 2011, of both genders, born preterm and term, coming from Hospital Wards (HW) and
Neonatal Intensive Care Units (Neonatal ICU), with
and without Risk Indicators for Hearing Impairment
(RIHI).
At present, the HMCP is a philanthropic teaching hospital belonging to PUC-Campinas, which attends SUS and private healthcare patients, whose
main users are inhabitants of the Northwestern and Southwestern regions of Campinas.
The irst stage of the study consists of collecting data from the medical records of newborns, whose data examined was: what are the Risk Indicators for Hearing Impairment (RIHI) that the Newborn presents; if they passed or failed the screening test; the rate of attendance in the case of failures
(retest); mothers age bracket; Newborn gender; weight at birth; newborn’s gestational age and the
Health Reference Centers (Basic health units) that
they belonged to.
To have a clearer view of the information, the
Of the NB who were screened, 379 (16%)
presented RIHI and 1955 (84%) did not present RIHI.
The rate of pass/fail of the 1st test carried out on
the NB with or without RIHI was observed. From the
total number of NB with or without RIHI, 1832 (78%) passed and 502 (22%) failed the screening. Table 1 presents the results of the test.
The data from Table 1 was analyzed using statis
-tical chi-square tests with a conidence interval of
5%. The test evaluates the relation between the two variables. With the p-value = 0,06, it isn’t possible to
afirm that there is a difference between the group
that “Passed” and the group that “Failed” when it
comes to the presence or not of a risk indicator. The Odds Ratio (OR) shows that the chances of passing with RIHI are smaller than the chances of passing without RIHI (chance of passing with RIHI is 283/96 = 2,94 and the chance of passing without RIHI is 1549/406 = 3,81).
to reduce the rate of false-positives, taking into consideration that some factors of outer and middle
ear can be solved through medical intervention
before being referred to brainstem auditory evoked
potential testing.
Lastly, the data collected from the medical records was analyzed quantitatively expressed in
numerical values and percentages, using the
statis-tical chi-square tests with a conidence interval of 5% and a statistical proportion test with a 5% signii -cance level.
RESULTS
Of the 2640 live newborns (hereinafter NB) at the HMCP in the city of Campinas - SP, 2334
(88%) passed through the SUS Neaonatal Hearing Screening.
Table 1 – Results of the irst test on the newborn with and without a risk indicator for hearing impairment
Passed Failed
p-value OR
N % N %
With RIHI 283 75% 96 25% 0,06 0,77
Without RIHI 1549 79% 406 21%
*Odds-Ratio – Is the odds ratio of an event occurring in a group and the odds of it occurring in another group.
The data in Table 1 was analyzed using statistical Chi-Square test with a conidence interval of 5%.
The pass-fail percentages of the NB with and
without RIHI were: 1549 (66%) passed the screening without RIHI; 283 (12%) passed with RIHI; 406
(17%) failed without RIHI; 96 (4%) failed with RIHI. The rate of newborns referred for diagnosis
was 89 (4%), including the NB that remained in
the Neonatal ICU and those who failed the second
retest.
Of the total number of NB who failed the
screening, 79,88% do not present RIHI and 18,92% do present RIHI.
Of the NB with RIHI 61,05% failed in only one ear, 36,84% failed with both ears and 2,11% did not conclude the test. On the retest of the NB with RIHI,
4,21% failed in only one ear, 10,53% failed in both ears and 26,32% did not return for the second test. 58,95% of the NB with RIHI passed the retest.
Of the NB without RIHI, 55,36% failed in only one ear, 39,90% failed in both ears and 4,74% did not
conclude the test.
For the retest of the NB without RIHI, 5,49% failed in only one ear, 5,24% failed in both ears and 24,94% did not show up. 66,58% of the NB without
RIHI passed the retest.
The proportion test did not indicate any
the test. Using a statistical proportion test with a
5% signiicance level no statistically signiicant difference was found between the proportions of each incidence in both groups (pass/fail).
Tables 3 and 4 present the number of NB per risk indicator for hearing impairment. It can be noted that family history is the most frequent indicator in NB, both in those who passed and those who failed
Table 2 – Information on the test results of newborns who failed the screening
Screening Results N % P-value
Total NB who failed 502 100.00%
Total NB who failed without RIHI 401 79.88%
Total NB who failed with RIHI 95 18.92%
1st Test – Unilateral fail without RIHI 222 55.36%
0,37
1st Test – Unilateral fail with RIHI 58 61.05%
1st Test – Bilateral fail without RIHI 160 39.90%
0,66
1st Test – Bilateral fail with RIHI 35 36.84% 1st Test – Not concluded without RIHI 19 4.74%
0,38 1st Test - Not concluded with RIHI 2 2.11%
Retest - Unilateral fail without RIHI 22 5.49%
0,8
Retest - Unilateral fail with RIHI 4 4.21%
Retest - Bilateral fail without RIHI 21 5.24%
0,09
Retest - Bilateral fail with RIHI 10 10.53% Retest - Not concluded without RIHI 1 0.25%
1 Retest - Not concluded with RIHI 0 0.00%
Retest – Did not show up without RIHI 100 24.94%
0,88 Retest - Did not show up with RIHI 25 26.32%
Retest – Passed without RIHI 267 66.58% 0,19
The proportion test did not indicate any statistically signiicant difference between the proportions of tests and retests with NB with or
without RIHI.
Table 3 – Risk indicators for hearing impairment in newborns who passed the screening
Risk indicators in NB who passed the screening
Family history 115 41%
Permanence in Neonatal ICU 72 25%
Prematureness 61 22%
Apgar 48 17%
Ototoxic medication 43 15%
Weight < 1500 g 8 3%
Ventilation 4 1.4%
Consanguinity amongst parents 3 1.1%
Intrauterine infections 3 1.1%
Acute Perinatal Anoxia 2 0.7%
SGA 2 0.7%
Craniofacial Anomalies 1 0.4%
and 2500g is 1.7 times higher than the chance of
passing with a weight lower than 1500g. And the
chance of passing with a weight greater than 2500g is 1.3 times greater than the chance of passing with
a weight smaller than 1500g.
Table 6 shows in percentages the subdivision of the regional Districts of the city of Campinas from where the NB who failed the test and will need to
be retested and those who presented RIHI and will
need biannual hearing monitoring came from.
Table 5 presents the demographical variables
and their association with the test result (pass/ fail). Considering a conidence interval of 5%, it is not possible to notice any statistically signiicant
association between the demographical variables and the test results.
Nearly all the Odds-ratio (OR) gave values close
to 1, meaning that the chance of passing at each of the variables was the same. Only the odds-ratio of the weight variable called attention: The chance of passing the test with a weight between 1500g
Table 4 - Risk indicators for hearing impairment in newborns who failed the screening Risk indicators in NB who failed the screening
Family history 38 40%
Apgar 21 22%
Permanence in Neonatal ICU 18 19%
Prematureness 11 11%
Ototoxic medication 6 6%
Consanguinity amongst parents 6 6% Weight < than 1500 g 3 3%
Intrauterine infections 3 3%
Acute Perinatal Anoxia 2 2%
Craniofacial Anomalies 2 2%
Syndromes associated with HI 2 2%
SGA 1 1%
Using the statistical proportions test with a signiicance interval of 5% no statistically signiicant difference between the proportions of each incidence in both groups (passed/failed) was noticed.
Table 5 – Demographic variables and association with the test result
Variables Passed Failed p value OR
Mother’s age
From 10 to 20 years 475 76.5% 146 23.5% 0.16 1.00 From 21 to 30 years 925 79.9% 232 20.1% 0.82 From 31 to 40 years 347 81.6% 78 18.4% 0.73 From 41 to 50 years 24 75.0% 8 25.0% 1.08
Gender
Female 918 79.2% 241 20.8% 0.56 1.06 Male 873 78.2% 244 21.8%
Weight at birth
< 1500g 15 83.3% 3 16.7% 0.28 1.00 Between 1500g and 2500g 134 74.4% 46 25.6% 1.72 > 2500g 1629 79.4% 423 20.6% 1.30
Gestational age
< 37 weeks 144 81.4% 33 18.6% 0.85 1.00 37 to 42 weeks 1617 80.0% 403 20.0% 1.09 > 42 weeks 2 100.0% 0 0.0%
Table 6 – Subdivision of Campinas city districts versus newborns who failed the screening and newborn with risk indicators for hearing impairment
District Failed With RIHI
North West 44,00% 38,00%
South 2,00% 0,80%
South West 16,00% 9,00%
North 0,40% 1,30%
RIHI: Risk Indicator for Hearing Impairment.
DISCUSSION
In this study, the percentage of newborns
screened in relation to the number born was 88%. Other research pointed to values varying between 61,2% 10; 94%, 96%, 52% 12; 68%, 88%, 80% 13;
95,2% 14; 62,17% 15.
In relation to the RIHI, it was noted that the
incidence in NB without RIHI was of 84% and of
16% in those with an indicator. Studies have shown
samples with more than 10% of newborns with RIHI, conirming this evidence when it came to the presence of the indicator in the following studies:
12% 12; 29% 14; and 6%, 12% and 14% 15.
In 2009, a study about the prevalence of risk indicators for deafness developed at the same insti
-tution (HMCP), pointed to a higher incidence of NBs
with some RIHI that year in relation to 2010, with a
rate of 25% in 2009 and 16% in 2010 16.
Amongst the most prevalent risk indicators
present in the pass/fail groups, the following
appeared in the greatest number: Family history and
complications coming from the neonatal ICU. Other
authors have also reached the same conclusion15-19.
Another study also relates this indicator with a
population of low risk NB8.
When it comes to the chances of passing/failing
in newborns with RIHI, it was noted that the chances
of passing with RIHI are lower than the chances of
passing without RIHI10.
Still in relation to risk indicators, it was also
analyzed whether there was a pass/fail relation with
the mother’s age, weight, gestational age and the
gender of the NB.
The weight variable called attention: it was
statistically shown that the chances of passing the
test with a weight between 1.500g and 2.500g is
1.7 times greater than the chances of passing with a weight smaller than 1500g. And the chances of
passing with a weight greater than 2.500g is 1.3
times bigger than the chances of passing with a
weight smaller than 1.500g.
In 2007, researchers concluded that the chance
of a newborn with a weight at birth smaller than 1.500g having a hearing loss is approximately 5.5 times higher than for those born weighing more than
1.500g; also observing that low weight at birth was associated with hearing loss20.
Prematurness and low weight at birth are generally concurrent, making it hard to separate
the factor associated to one or another. Being that
newborn when born with a low weight, lower than
1.500g, present various factors which may lead to
brain damage or hearing loss21,22.
With regards to the screening results, it was seen that 1832 (78%) passed the screening and 502
(22%) failed. This data representing higher rates than in the previous study from the same institution,
with a 58% pass rate16.
Also, the failure rates observed are high in relation to the recommendations of the Joint Committee on Infant Hearing, which suggests that this rate should
not surpass 4% before being discharged from
hospital3.
Other studies reveal a pass/fail rate of 73,3%
Pass and 26,7% Fail 14. 90,50% Pass and 9,50%
Fail10.
It can be seen that a large number of the studies
related to NHS were developed in University Hospitals, as is the case with this study. Together with this, with each new year, new Residents,
teachers and students take on the responsibility of
carrying out the Neonatal Hearing Screening, where
time is needed to acquire experience in carrying out
the tests.
This experience is an important indicator in relation to the factors that can interfere in the results received from the EOAE, such as the state of consciousness of the newborn, the displacement of the probe through the external ear canal, placement of the probe, localization and noise 23.
healthcare plans together with the number the live
births from the Sistema Único de Saúde.
The screening’s high reach index can be justiied by the fact that the test must be carried out up to
48 hours, or prior, to hospital discharge, being that screening during admission is prioritized, be it via the SUS or through a private healthcare plan. The
availability of staff and their weekend shifts can also
contribute to this goal14. It can also be understood
that carrying out the tests throughout all week
without interruptions, also consists of a decisive factor in the effectiveness of the UNHS Programs 16.
The rate of newborn referred to diagnosis was 89 (4%), reaching the recommendations for veriication of quality indicators.
To achieve success in the implementation of
NHS Programs prevention actions are also
recom-mended, as well as the territorialization of demand.
For this, in this study we carried out the mapping
of the newborns that passed and failed the
screening and those who will need biannual hearing monitoring.
Although other regions do use the Hospital
services, the regions of the Northwest and Southwest district of Campinas concentrate the greatest number of newborns who pass through the
NHS.
CONCLUSION
A study like this one allows for the active search of newborns from the risk group for hearing impairment
in their respective territories, with a higher possibility
of accompaniment of the NBs and in this manner, reaching the primary goal of hearing screening that is the diagnosis of deafness by the newborn’s third month of life, developing an effective NHS Program
in two stages: screening, hearing diagnosis,
indication, selection and adaptation of hearing aids
and hearing re(ha)bilitation.
involved led to a fall in the rate of referrals and
false-positives 19.
When it comes to the results of the screening, amongst the NB who failed the screening with and without RIHI, unilateral failure was observed
in 61,05% (with indicator) and 55,36% (without
indicator); bilateral failure in 36,84% (with indicator)
39,90% (without indicator).
In the retest the following was found: unilateral failure in 4,21% (with indicator) and 5,49% (without indicator); bilateral failure in 10,53% (with indicator)
and 5,24% (without indicator); 26,32% (with indicator) and 24,94% (without indicator) did not
show up for the retest; and 58,95% (with indicator)
and 66,58% (without indicator) passed the retest.
The following authors also described similar results in unilateral failure in the irst test, with percentages that vary of: 67,3% 10; 62,6% 14;
61,5% 24.
In retests other studies present the following failure percentages: 6,6% 14; 23,81% to 39,91% 6,24.
In relation to the adhesion of the studied population to the retest it was observed that approxi -mately 73,68% (with indicator) and 75,06% (without
indicator) showed up for the retest. This data is close
to what other studies show: 68,2% 14 and 73,1% 6. The number of newborns referred to diagnosis
was 89 (4%), including the NB who remained in
the Neonatal ICU and those who failed the second
retest.
To evaluate the effectiveness of the NHS Program of the HMCP, the veriication of the quality indicators was carried out, which were: rate of
screening carried out superior to 95% amongst live
newborns, trying to reach a rate of 100% amongst
live newborns; screening carried out during the
newborn’s irst month and with a rate of newborns referred to diagnosis inferior to 4%3.
8. Beckwith L, Rodning C. Intellectual functioning in children born preterm: recent research. In:
Okagaki L, Sternberg RJ. Directors of development inluences on the development of the children´s
thinking. Hillsdale: Lawrence Erlbaum Associates, 1991, p. 25-58.
9. Organização Mundial da Saúde. Classiicação estatística internacional de doenças e problemas
relacionados à saúde: 10ª revisão. v. 1. São Paulo: Centro Colaborador da OMS para a Classiicação de Doenças em Português/EDUSP; 1994.
10. Pádua FGM, Marone S, Bento RF, Carvalho RMM, Durante AS, Soares JC, et al. Triagem Auditiva
Neonatal: um desaio para sua implantação. Arq
Otorrinolaringol. 2005;3(9):190-4.
11. Nóbrega M. Estudo da deiciência auditiva em crianças e adolescentes, comparando-se os períodos de 1990 a 1994 e 1994 a 2000. [tese]. São
Paulo (SP): Universidade Federal de São Paulo/
EPM; 2004.
12. Barreira-Nielsen C, Futuro NHA, Gattaz G.
Processo de implantação de Programa de Saúde Auditiva em duas maternidades públicas. Rev. soc. bras. fonoaudiol. 2007;12(2):99-105.
13. Mello JM, La Puente LF, Sawasaky LY,
Rosa VAD. Triagem Auditiva Neonatal: análise
comparativa de critérios de qualidade em dois anos consecutivos. 26º Encontro Internacional de Audiologia; 2011; Maceió. p. 3029.
14. Mattos WM, Cardoso LF, Bissani C, Pinheiro
MMC, Viveiros CM, Carreirão FW. Análise da
implantação de programa de triagem auditiva
REFERENCES
1. Joint Committee on Infant Hearing. 1994 position statement. Audiol Today. 1995;6:6-9.
2. Araújo FCR, Almeida EC, Arroyo NL. Avaliação Audiológica do Recém-Nascido. In: Almeida EC,
Modes LC. Leitura do Prontuário – Avaliação e
Conduta Fonoaudiológica com o Recém-Nato de Risco. Rio de Janeiro: Revinter, 2005, p. 61-80. 3. Joint Committee on Infant Hearing. Year 2007
Position Statement: principles and guideslines for
early hearing detection and intervention programs. Pediatrics. 2007;120(4):898-921.
4. Lewis DR, Marone SAM, Mendes BCA, Cruz
OLM, Nóbrega M. Comitê multiproissional em saúde auditiva: COMUSA. Braz. j. otorhinolaryngol.
(Impr.) [serial on the Internet]. 2010 Feb [cited 2013 May 08];76(1):121-8.
5. National Institutes of Health Consensus
Development Conference Statement. Early identiication of hearing impairment in infants and
young children. Int J Pediatr Otorhinolaryngol. 1993;27(3):215-27.
6. Durante AS, Carvallo RMM, Costa MTZ, Cianciarullo MA, Voegels RL, Takahashi GM, et al. Programa de TAN: modelo de implementação. Rev Arq Int Otorrinolaringol. 2004;8(1):56-62.
7. BRASIL, Lei nº 12.303, de 2 de agosto de
2010. Disponível em: http://www.planalto.gov. br/ccivil_03/_Ato2007-2010/2010/Lei/L12303. htmAcesso em 23 de junho de 2013
RESUMO
Objetivo: caracterizar a demanda, território e exames auditivos realizados em um Programa de
Triagem Auditiva Neonatal. Métodos: estudo retrospectivo de uma amostra de 2334 prontuários de
recém-nascidos triados, envolvendo a análise de dados referentes à Triagem Auditiva Neonatal, infor
-mações dos Recém-nascidos e variáveis demográicas. Resultados: foram triados 88% dos recém
--nascidos, e destes 16% apresentavam Indicador de Risco para Deiciência Auditiva e 84% não apre
-sentavam. Observou-se que o indicador mais prevalente foi o histórico familiar, e que as chances
de passar no teste são menores quando na presença de indicador e quando o recém-nascido
apre-sentava peso inferior a 1.500g. O índice de passa-falha no teste foi de 78% passa e 22% falha. No resultado do teste, maior número de falhas unilaterais, e no reteste falha de 4% sendo a adesão de
mais de 70%. Conclusão: estudo como este possibilita a busca ativa dos recém-nascidos do grupo
de risco para deiciência auditiva em seus respectivos territórios, havendo maior possibilidade de seguimento e assim, chegar ao objetivo primordial da triagem auditiva que é o diagnostico da surdez até o terceiro mês de vida, além de projetar um Programa de Triagem Auditiva Neonatal efetivo em
suas etapas: triagem, diagnóstico audiológico, indicação, seleção e adaptação de aparelhos auditivos e re(ha)bilitação auditiva.
20. Tiensoli LO, Goulart LMHF, Resende LM,
Colosimo EA. Triagem auditiva em hospital público de Belo Horizonte, Minas Gerais, Brasil: deiciência auditiva e seus fatores de risco em neonatos e lactentes. Cad. Saúde Pública. 2007;23(6):1431-41.
21. Northern JL, Downs MP. Audição na infância. 5ª Ed. Rio de Janeiro: Artmed Editora; 2005.
22. Bittencourt AM, Mantello EB, Manfredi AKS, Santos CB, Isaac ML. Fatores de risco
para deiciência auditiva em recém-nascidos acompanhados no berçário de risco do Hospital
das Clínicas da Faculdade de Medicina de Ribeirão Preto – Universidade de São Paulo. Fono Atual. 2005;8:41-52.
23. Chapchap Mônica Jubran, Segre Conceição Mattos. Universal newborn hearing screening and transient evoked otoacoustic emission: new concepts in Brazil. Scand Audiol Suppl. 2001;53:33-6.
24. Wroblewska-Seniuk K, Chojnacka K, Pucher B, Szczapa J, Gadzinowski J, Grzegorowski M. The
results of newborn hearing screening by means of
transient evokes otoacustic emissions. Int J Pediatr Otorhinolaryngol. 2005;69(10):1351-7.
neonatal em um hospital universitário. Rev. Bras.
Otorrinolaringol. 2009;75(2):237-44.
15. Pereira PKS, Martins AS, Vieira MR, Azevedo MF. Programa de triagem auditiva neonatal:
associação entre perda auditiva e fatores de risco.
Pró-Fono R. Atual. Cient. 2007;19(3): 267-78.
16. Amado BCT, Almeida EOC, Berni PS. Prevalência de indicadores de risco para surdez em neonatos em uma maternidade paulista. Rev. CEFAC. 2009;11(1):18-23.
17. Azevedo MF. Triagem auditiva neonatal. In:
Ferreira LP, Bei-Lopes DM, Limongi SCO. Tratado de fonoaudiologia. São Paulo: Rocca, 2004. p.
604-16.
18. Lima GML. Análise da triagem auditiva por
audiometria automática de tronco encefálico de
recém-nascidos internados em unidade de cuidados
intensivos e intermediários. [tese]. Campinas (SP): Universidade Estadual de Campinas/ FCM; 2004.
19. Freitas VS, Alvarenga KF, Bevilacqua MC,
Martinez MAN, Costa OA. Análise crítica de três
protocolos de triagem auditiva neonatal. Pró-Fono R. Atual. Cient. 2009;21(3):201-6.
Received on: February 12, 2013 Accepted on: July 22, 2013 Mailing address:
Amanda Ferreira Hernandez Rogério Rua Maria de Almeida Magalhães, 426 – Jardim Atibaia – Sousas
Campinas – São Paulo – Brasil CEP: 13106-016
